Medial Malleolus Fracture and Broken Ankle Treatment

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The medial malleolus is the bony bump on the inner side of the ankle. This is the end of the shinbone (tibia) and forms the support for the inner side of the ankle joint. The medial malleolus is also the attachment of the major ligament on the inner side of the ankle, called the deltoid ligament.

Fractures of the medial malleolus are relatively uncommon. When they do occur, they are usually part of a more complex pattern of ankle fractures, including bimalleolar fractures (involving the medial malleolus and the lateral malleolus, or outer side of the ankle) and trimalleaolar fractures (involving these two parts along with the posterior malleolus, or back of the tibia).

This article explains what medial malleolus fractures are, as well as their causes and symptoms. It also addresses treatment options and their potential complications.

X-ray of fractured medial malleolus

Sopone Nawoot / Getty Images

Types

There are five types of medial malleolus fractures:

  • Chip fractures are caused by ligaments separating from the bone, rather then an injury.
  • Comminuted fractures are those in which a bone is broken in multiple places.
  • Oblique fractures often occur at the corner of the ankle joint and are a sign of an unstable ankle.
  • Transverse fractures occur in the same direction as the ankle joint line.
  • Vertical fractures happen when the force of an injury is oriented more in the leg bone.

Causes

An isolated fracture of the medial malleolus generally occurs when the foot is forcefully rolled inward or outward. When the foot rolls inward, it causes a compression of the medial malleolus on the inner side of the ankle. When the foot rolls out, it puts tension on the medial malleolus, which can also cause a fracture.

Medial malleolus fractures can also be stress fractures. In these cases, there is no forceful injury. Rather, the repetitive stress of an activity causes the bone to weaken. Stress fractures of the ankle are most often seen in endurance athletes and military recruits.

Anatomy of the Ankle

The ankle joint consists of three bones: the shinbone (tibia); the smaller bone of the lower leg

(fibula); and a small bone that is nestled between the heel and these two bones (talus).

Symptoms

Fractures of the medial malleolus cause symptoms such as:

If these symptoms occur, make an appointment with your healthcare provider to determine the source of your ankle pain. There are well-established criteria to determine if an X-ray is necessary. Most fractures are readily visible on X-rays, so further tests usually aren't needed.

A medial malleolus fracture prompts concern about other possible damage to the joint that may occur as part of typical injury patterns. This can include bones as well as ligaments (the tissues that connect bone to bone) and tendons (tissues that connect muscle to bone).

Any patient with a medial malleolus fracture should be carefully examined so the full extent of an injury can be confirmed.

Complications

Long-term, this type of injury can lead to early ankle arthritis—even if the bone heals well (which most do) and is properly treated. Ankle arthritis causes symptoms such as pain with movement, joint stiffness, and difficulty putting weight on the ankle.

This can happen if cartilage inside the ankle joint is also damaged at the time of the injury.

Treatment

There are both surgical and non-surgical options to treat medial malleolus fractures. The one that is best for you depends on how the fracture has impacted the ankle joint.

Immobilization

Immobilizing a fracture (meaning, reducing or eliminating motion) is often preferred if the fragment of bone is too small to negatively affect the overall stability of the alignment of the joint.

Fractures usually are treated with a short leg cast or a removable brace, often called a boot.

One study found that patients who wore a walking boot were able to both put their full weight on the affected ankle and walk without crutches faster than those patients who wore a plaster cast. A potential reason? The researchers suspected it is because walking boots are simple to put on. And as swelling in the ankle goes up and down during recovery, the ankle adjusts well to the interior of the boot.

Many patients prefer this non-surgical tactic. But for it to succeed, they must avoid putting weight on the affected leg for about six weeks.

Several studies have documented proper healing of medial malleolus fractures without surgery. In most of these cases, the ankle joint was not out of position. 

Surgery

In general, most healthcare providers only recommend surgery for fractures that can affect the stability or the alignment of the joint.

Surgery is usually done immediately, before any swelling has developed, or after days or even weeks of waiting for the swelling to subside. Time allows the soft tissues to become healthy again at the time of the procedure, which can reduce surgical risks.

For fractures that are not well-positioned, a surgical procedure to line up and stabilize the bone is often recommended. The bone usually is held in position with metal screws, although there are several other options that can be considered based on the particular fracture pattern. These include placement of a plate and screws or wiring techniques.

Depending on the type of fracture, your surgeon may be able to directly visually inspect the cartilage during the surgery to look for signs of damage. Other surgeons may opt to perform an ankle arthroscopy at the time of repair to better see the cartilage. This minimally invasive procedure involves making two small incisions to gain access to the ankle joint.

Recovery

It takes at least six weeks for a broken bone to heal. More time will be added to your recovery if any ligaments or tendons have been damaged. Expect your healthcare provider to monitor your progress with more X-rays.

The ankle joint is treated with particular caution after surgery because only a thin layer of skin covers the surgical repair. To guard it as it heals, you can expect to be placed in a splint before moving on to a removable brace or cast.

Whether you follow a surgical or non-surgical treatment plan, physical therapy will probably play a big role in your recovery. When you're ready, you will begin to exercise and strengthen your ankle.

The rehabilitation process can take time. It may be several months before your muscles are strong enough for you to start putting weight on your ankle. Your healthcare provider will be watching carefully and will not give you the all-clear until your ankle is stable enough.

It's natural to become impatient during this period. But it's vital not to put weight on your ankle prematurely because it could cause your surgical repair to fail completely. If that happens, you would have to begin the process all over again.


Following your rehabilitation program to the T is crucial. It can reduce the risk of long-term pain and complications.

As the wound heals, it's equally important to avoid infecting the surgical site and to follow all of your physician's instructions regarding physical therapy, activity level, proper rest, and wound care.

The speed and quality of your recovery depend on your diligence.

Summary

Fractures of the medial malleolus are relatively uncommon and usually occur as part of a more complex pattern of ankle fractures. The injury occurs when the foot is forcefully rolled inward or outward.

The symptoms of a medial malleolus fracture are fairly predictable: Pain on the inner side of the ankle, swelling and bruising, and difficulty walking.

Non-surgical and surgical options exist to treat medial malleolus fractures, but the choice often comes down to the extent of the fracture. Expect a minimum of six weeks to recover.

A Word From Verywell

Try to remember that dealing with an ankle fracture can be tricky: You need to give it time to heal properly, but your ankle won't get stronger without proper exercise.

If you're not sure if you're doing what's best for your recovery, speak to your healthcare team. Be sure to keep them in the loop about any problems you may have following their recommendations, as well as any setbacks you may encounter.

Frequently Asked Questions

  • Where in the body is the medial malleolus?

    The medial malleolus is at the end of the tibia. It is the bony bump on the interior side of the ankle that provides support for that side of the ankle joint.

  • How common is a medial malleolus fracture?

    Isolated medial malleolus fractures are relatively uncommon, but they do occur. Medial malleolus fractures are typically part of a more complex ankle injury.

  • Can you walk on a medial malleolus fracture?

    It depends on the severity. With a chip or avulsion fracture, once you have a walking cast or boot, you may be able to put pressure on the foot after a day or two, depending on your pain level. Severe fractures often require surgery. With these, you'll need to be off your feet for several weeks.

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